Provider Demographics
NPI:1083936736
Name:ONDERSMA, NICHOLE T (LMSW)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:T
Last Name:ONDERSMA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:COMPASSIONATE
Other - Middle Name:
Other - Last Name:CONNECTION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:2790 CARMEL ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6510
Mailing Address - Country:US
Mailing Address - Phone:734-604-0654
Mailing Address - Fax:
Practice Address - Street 1:2790 CARMEL ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6510
Practice Address - Country:US
Practice Address - Phone:734-604-0654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI680108676451041C0700X
680108676451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker